Association Between Palliative Care in the Emergency Department and Cardiopulmonary Resuscitation Decisions in Patients with Poor Prognosis: A Retrospective Observational Study
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Background: Integrating palliative care (PC) into emergency departments (EDs) is increasingly recognized as a strategy to support decision-making and avoid non-beneficial interventions near the end of life. However, evidence remains limited regarding its association with cardiopulmonary resuscitation (CPR) decisions in patients with poor prognosis. Methods: We conducted a retrospective cohort study at a tertiary emergency hospital in Brazil, including adult inpatients who died between 2014 and 2024. The primary outcome was the occurrence of CPR during hospitalization. Patients were classified based on whether they received a PC consultation. Time to CPR was analyzed using Cox proportional hazards models adjusted for age, sex, comorbidities, and admission year. CPR attempts were identified using a validated natural language processing (NLP) approach applied to electronic health records (EHRs), with a Kappa agreement of 0.70 (95% CI: 0.61–0.79) compared to manual chart review. Results: Among 6,211 patients, 1,638 (26.3%) received a PC consultation before death. PC consultation was independently associated with a lower likelihood of CPR, with an adjusted hazard ratio (HR) of 0.35 (95% CI: 0.32–0.39; p < 0.001). In a sensitivity analysis limited to patients who died within 24 hours of admission, the association remained significant (HR: 0.26; 95% CI: 0.18–0.37; p < 0.001). Conclusions: PC consultation in the ED was associated with a significantly lower incidence of CPR among patients with limited prognosis. These findings highlight the importance of early palliative care integration in acute care settings to support goal-concordant decision-making and reduce potentially non-beneficial interventions at the end of life. Keywords: Palliative care; Emergency department; Cardiopulmonary resuscitation; End-of-life decisions; Natural language processing; Retrospective cohort.
